Transfer to a New Club

This transfer is for:* Athlete Nonathlete
Is this a transfer from one CT club to another CT club?* Yes No
Is this a transfer from a club outside the state of CT?* Yes No
Last Name:*
First Name:*
Middle Name. If none, enter None:*
Nickname or Preferred Name:
Address:
City:
State:
Zipcode:
Date of BIrth mm-dd-yyyy:*
Gender:* Male Female
Name of LSC and club you are leaving:*
Name of CT club you are transferring to:*
Name of person responsible for this transfer request:*
Email:*
Phone:
Please allow 1-2 business days for processing.
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